Healthcare Provider Details

I. General information

NPI: 1497212799
Provider Name (Legal Business Name): EDGAR JOEL CRUZ CRISPIN DNP, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2019
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17835 MURDOCK CIR UNIT A
PORT CHARLOTTE FL
33948-4091
US

IV. Provider business mailing address

17835 MURDOCK CIR UNIT A
PORT CHARLOTTE FL
33948-4091
US

V. Phone/Fax

Practice location:
  • Phone: 941-340-3636
  • Fax: 941-340-3637
Mailing address:
  • Phone: 941-340-3636
  • Fax: 941-340-3637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11001601
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11001601
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: